SUMMARIES OF 16
COMMONWEALTH REPORTS
Mar - Apr 2002
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U.S. RESIDENTS FACE MOST
SEVERE PROBLEMS IN ACCESS TO HEALTH CARE OF FIVE NATIONS
The United States has the highest share of residents facing access problems, driven in large part by the difficulty many face in paying for care. At least one of five Americans reported problems paying their medical bills, filling prescriptions, getting medical care when they had a problem, or
in getting a physician-recommended test. Americans with below-average income reported more health care access problems than their counterparts in the other four countries.
The survey conducted in April and May 2001, examined citizens' views of and experiences with health care systems in Australia, Canada, New Zealand, the United Kingdom, and the United States.
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MINORITY AMERICANS LAG BEHIND WHITES ON HEALTH CARE QUALITY
On a wide range of health care quality measures including effective patient-physician communication, overcoming cultural and linguistic barriers, and access to health care and insurance coverage minority Americans do not fare as well as whites. African Americans, Asian Americans, and Hispanics are more likely than whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor, and to feel they would receive better care if they were of a different race or ethnicity. While the health care experiences of different minority groups do vary significantly, many common concerns emerge. The survey findings also frequently reveal wide variation within racial and ethnic groups.
Minority Americans are more likely than whites to have negative experiences in the health care system. Nearly one of six African Americans (15%), one of seven Hispanics (13%), and one of ten Asian Americans (11%) feel they would receive better health care if they were of a different race or ethnicity, compared with 1% of whites. Hispanics are also twice as likely as whites to feel treated with disrespect either because of their ability to pay, ability to speak English, or because of their race or ethnicity (18% vs. 9%). Sixteen percent of African Americans felt treated with disrespect, as did 13% of Asian Americans.
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AFRICAN AMERICANS ARE LESS LIKELY TO RECEIVE RECOMMENDED CLINICAL CARE
African Americans are less likely than whites to receive recommended clinical care in four key quality areas, according to a new study of Medicare managed care enrollees published in the March 13, 2002, issue of the Journal of the American Medical Association (JAMA) . Among Medicare beneficiaries enrolled in managed care plans, African Americans were less likely than whites to receive follow-up care after a hospitalization for mental illness (33.2% vs. 54.0%), eye exams if they were diabetic (43.6% vs. 50.4%), beta-blocker medication after a heart attack (64.1% vs. 73.8%), and breast cancer screening (62.9% vs. 70.2%). After adjustment for factors including age, sex, Medicaid insurance, income, education, rural residence region, and plan, racial disparities were still significant for every measure except breast cancer screening. Within the same health plan, African Americans received lower quality of care than whites on three of the measures (follow-up after hospitalization for mental illness, diabetic eye exams, and beta-blockers after heart attack). For the fourth measure (breast cancer screening), the disparity was linked to higher enrollment by African Americans in managed care plans of lower overall quality.
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INCREASED COST-SHARING FOR MEDICARE+CHOICE BENEFICIARIES
This by Lori Achman and Marsha Gold, analyzes trends in benefits and premiums in the Medicare managed care program, documenting a downward trend in benefit generosity. While increases in monthly premiums will affect all enrollees, sicker beneficiaries will bear the brunt of changes in the structure of prescription drug benefits and cost-sharing requirements as more plans restrict drug coverage to generics only and raise cost-sharing requirements for services such as inpatient and outpatient hospital care.
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Employers Say Increases in Cost-Sharing for Rx Benefits and Higher Premiums Are on the Horizon for Retirees
Retiree health benefits are the largest source of supplemental coverage for Medicare beneficiaries. More than one-third of seniors almost 14 million people on Medicare receive health insurance from an employer plan. Such health coverage is critical for seniors seeking to fill gaps in Medicare for such expenses as prescription drugs and cost-sharing requirements. The new 2001 Retiree Health and Prescription Drug Coverage Survey profiles retiree health coverage for Medicare-age (65+) retirees, including the amount retirees pay for coverage compared to active workers, cost-sharing for prescription drugs, and eligibility requirements for retiree benefits.
The survey findings include: 1) that the availability of coverage in firms of all sizes is declining. 2) that retirees with health benefits tend pay a more substantial share of the premium than active workers and 3) that 32% of employers plan to introduce three-tier cost-sharing formulas for drugs within the next two years, which will require retirees to pay more for non-generic drugs.
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IN PURSUIT OF LONG TERM CARE
Concludes that a new system of financial support is needed to assure that all elderly and disabled Americans have access to quality long-term care. Necessary steps include monitoring quality of care, upgrading skill of workers in long term care and providing enhanced support to long term caregivers at home.
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MEDICARE + CHOICE ENROLLMENTS
The majority of the nation's elderly remain in fee-for-service medicare rather than the managed care medicare known as Medicare Plus Choice. Despite repeated legislative adjustments health insurers continue to withdraw from this market. The Bush Administration remains determined to rectify shortcomings and to expand enrollment.
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INTERNET-BASED PRODUCTS PART OF BURDEN SHIFT TO EMPLOYEES
E-health tools-new internet-based products that some employers and employees are now using to manage health benefits-offer some advantages but may contain potential pitfalls such as increased costs and reduced access to coverage for older and sicker employees. Although e-health tools have the potential to provide greater control to consumers and lower overall costs for administering benefits, users should be wary of long- and short-term effects that could offset these benefits. Increased financial burdens for employees as health care costs rise faster than employer contri-butions, and adverse risk selection that could increase costs and limit choice for some employees, are some possible negative effects, specifically from e-health defined contribution plans. The authors encourage employers to be cautious in making the transition from traditional ways of administering health plans to e-health systems.
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Providing health insurance for parents of young children and helping states improve delivery of early child development services through their Medicaid programs are the subjects of two new reports prepared by the National Academy for State Health Policy with support from The Commonwealth Fund. In Options for Assisting Uninsured Parents in Securing Basic Health Services, authors Sara Rosenbaum and Colleen Sonosky of George Washington University analyze various approaches to financing health services for low-income parents who lack insurance. They also explore key federal programs offering health care to low-income people and provide state policymakers with options for creating sources of care for uninsured parents. The second report examines how North Carolina, Utah, Vermont, and Washington have improved delivery of child development services through their Medicaid programs. The report, Building State Medicaid Capacity to Provide Child Development Services: Early Findings from the ABCD Consortium, is by Deborah Curtis of the National Academy of State Health Policy in Portland, ME.
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MEDICAL OR PRESCRIPTION DRUG ERRORS
The Commonwealth Fund estimates that more than one of five American families (22%), or approximately 8.1 million households, have experienced a medical or prescription drug error that turned out to be very serious. In Room for Improvement: Patients Report on the Quality of Their Health Care, Karen Davis and colleagues also find that many Americans fail to get preventive health services at recommended intervals or receive substandard care for chronic conditions, which can translate into needless suffering, reduced quality of life, and higher long-term health care costs. The study was based on the Commonwealth Fund 2001 Health Care Quality Survey.
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Women belonging to racial and ethnic minorities feel
disrespected
Women belonging to racial and ethnic minority groups are more likely than white women to have difficulty communicating with their doctors and to feel they are treated disrespectfully in health care settings. At the same time, they are less likely than white women to have health insurance or to see both a primary care provider and an obstetrician/gynecologist. These and the other findings from The Commonwealth Fund 2001 Health Care Quality Survey were reported and discussed at the Margaret E. Mahoney Annual Symposium, held today in Washington, D.C., by the Jacobs Institute of Women's Health and The Commonwealth Fund.
Women who are members of racial and ethnic minority groups are more likely than white women to have difficulty communicating with their doctors, to feel they are treated disrespectfully in a health care setting, and to go to the emergency room for health care. They are less likely than white women to have health insurance or to see both a primary care provider and an obstetrician/gynecologist. Women of color also believe that they would receive better health care if they were of a different race or ethnicity. These and the other barriers that prevent women of color from accessing quality health care were reported and discussed at a national symposium here today.
"Difficulty getting health care, difficulty communicating with a doctor, difficulty paying for health care, and racial or ethnic bias in the health care system all harm women's health," said Martha Romans, Executive Director of the Jacobs Institute for Women's Health. "Working for better women's health care means working to eliminate these disparities."
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TAX CREDITS NOT EFFECTIVE
Proposed tax credits designed to help uninsured Americans buy individual health coverage would not be effective for adults age 55 and older, according to a new study released on April 17 on the Health Affairs website, www. healthaffairs.org. The study also found that individual coverage costs considerably more than group health plans while providing inferior benefits, a finding that was true for young adults as well as for older adults.
While the study found that a $1,000 tax credit would be adequate for a healthy male in his 20s, that amount would cover less than half the annual premium costs for the majority of individual health plans available to a healthy 55-year-old man. Moreover, many individual plans provide neither prescription drug benefits nor mental health coverage.
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BARE-BONES HEALTH PLANS
The report Bare-Bones Health Plans: Are They Worth the Money?, by Sherry Glied of Columbia University, Cathi Callahan and James Mays of Actuarial Research Corporation, and Jennifer N. Edwards of The Commonwealth Fund, finds that a less-expensive health insurance product would leave low-income adults at risk for high out-of-pocket costs that could exceed their annual income. The authors conclude that a safeguard similar to that provided by the State Children's Health Insurance Program (CHIP)-a spending cap of 5 percent of annual income for low-income families-would be needed in conjunction with any move toward a stripped-down benefit package.
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CAUGHT IN BETWEEN
Caught in Between: Short-Term Uninsured Can Pay Heavy Price
A recent survey examining health insurance coverage within the U.S. workforce has found that being uninsured, even for a short time, can have long-term health and economic consequences. Insured adults who had experienced a time without any health coverage during the past year were equally as likely to experience problems paying medical bills and accessing health care as those who were uninsured at the time of the survey. Together, these two groups account for one of four working-age Americans, or 38 million people ages 19 to 64.
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GENERATING A SPIKE IN UNINSURANCE
The 2001 economic downturn may generate a spike in the number of Americans who will lose their health insurance and ability to get needed health care, according to a recent study documenting the link between loss of job and loss of health coverage. An estimated 37 percent of unemployed adults are uninsured and, consequently, at great financial risk.
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PREVENTIVE CARE FOR WOMEN LINKED TO RACE, INCOME
The good news from a new analysis of health care for midlife women is that a majority of all women ages 45 to 64 are getting good preventive care. The bad news is that lower-income and minority women, especially blacks and Hispanics, are disproportionately less likely to receive a number of health services that are highly recommended for older women, including mammograms and counseling on use of hormone replacement therapy.
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